There are two common approaches to heparin administration for pediatric bypass: one involves the empirical dosing of heparin based on the activated clotting time (ACT), and the other on heparin concentration. It has been observed that heparin requirements are substantially greater when maintaining a concentration as opposed to an ACT. This study gathered heparin administration data from five pediatric centers, two using an empirical regimen and ACT technique and three using heparin concentration as measured by the Heparin Management System (HMS). All patients less than or equal to 20 kg were evaluated and grouped by technique. There were 49 patients in the HMS group and 46 in the ACT group. There was no significant difference between groups for patient weight, bypass time, postheparin ACT, bypass ACT, protamine dose, or 24-h blood loss (mL/kg/24). There was a significant difference (p < .01) for prime heparin (4.7 ± 1.3 units/cc HMS vs. 1.9 ± 0.4 units/cc ACT), heparin loading dose (476.5 ± 175.3 units/kg HMS vs. 384.6 ± 54.3 units/kg ACT), and total heparin (16.6 ± 6.7 units/kg/min HMS vs. 9.5 ± 5.9 units/kg/min ACT). The use of the HMS for heparin management in pediatric bypass required more heparin but no difference in protamine use or 24-h blood loss.
有两种常见的肝素给药方法:一种是根据活化凝血时间(ACT)给药，另一种是根据肝素浓度给药。已经观察到，当维持一个浓度时，肝素的需要量比ACT大得多。本研究收集了来自5个儿科中心的肝素给药数据，其中2个使用经验方案和ACT技术，3个使用肝素管理系统(HMS)测量的肝素浓度。所有小于或等于20kg的患者均进行评估并按技术分组。HMS组49例，ACT组46例。两组患者体重、搭桥时间、肝素后ACT、搭桥ACT、鱼精蛋白剂量、24小时失血量(mL/kg/24)均无显著差异。主要肝素(4.7±1.3单位/cc HMS vs. 1.9±0.4单位/cc ACT)、肝素负荷剂量(476.5±175.3单位/kg HMS vs. 384.6±54.3单位/kg ACT)和总肝素(16.6±6.7单位/kg/min HMS vs. 9.5±5.9单位/kg/min ACT)差异有统计学意义(p < 0.01)。在小儿旁路手术中使用HMS进行肝素管理需要更多的肝素，但在鱼精蛋白使用和24小时失血量方面没有差异。
{"title":"Heparin Use in Pediatric Bypass—Empirical Regimen (ACT) vs. Heparin Concentration: A Multicenter Trial","authors":"V. Olshove, R. Tallman","doi":"10.1051/ject/2000322084","DOIUrl":"https://doi.org/10.1051/ject/2000322084","url":null,"abstract":"There are two common approaches to heparin administration for pediatric bypass: one involves the empirical dosing of heparin based on the activated clotting time (ACT), and the other on heparin concentration. It has been observed that heparin requirements are substantially greater when maintaining a concentration as opposed to an ACT. This study gathered heparin administration data from five pediatric centers, two using an empirical regimen and ACT technique and three using heparin concentration as measured by the Heparin Management System (HMS).\u0000All patients less than or equal to 20 kg were evaluated and grouped by technique. There were 49 patients in the HMS group and 46 in the ACT group.\u0000There was no significant difference between groups for patient weight, bypass time, postheparin ACT, bypass ACT, protamine dose, or 24-h blood loss (mL/kg/24). There was a significant difference (p < .01) for prime heparin (4.7 ± 1.3 units/cc HMS vs. 1.9 ± 0.4 units/cc ACT), heparin loading dose (476.5 ± 175.3 units/kg HMS vs. 384.6 ± 54.3 units/kg ACT), and total heparin (16.6 ± 6.7 units/kg/min HMS vs. 9.5 ± 5.9 units/kg/min ACT). The use of the HMS for heparin management in pediatric bypass required more heparin but no difference in protamine use or 24-h blood loss.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126265428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Golab, M. Wijers, M. Witsenburg, G. Bol-Raap, E. Cruz, A. Bogers
Moderate hypothermia of 28°C is widely accepted in cardiac surgery with cardiopulmonary bypass (CPB). Recently, however, several studies suggested that normothermic or “tepid” bypass techniques may improve the clinical outcome for patients undergoing cardiac operations. To assess the effect of bypass temperature management strategy in pediatric patients undergoing correction of ventricular septal defect, 26 patients with body weight under 10 kg were randomly assigned to two treatment groups: Group 1, mild hypothermia, patients cooled to nasopharyngeal temperature of 32°C during the bypass; or Group 2, moderate hypothermia of 28°C. Clinical parameters were recorded, and blood samples were obtained just before, during, and 24 hours after operation. All the population characteristics and intraoperative variables were similar in the two groups. Hematologic data after CPB and protamine administration revealed a significantly (p < .05) longer activated partial thromboplastin time in the 32°C group; however, the difference in blood loss did not reach significance. Our study shows that both perfusion temperatures equally well facilitated CPB for this type of intracardiac surgery.
{"title":"The Effect of Temperature Management During Cardiopulmonary Bypass on Clinical Outcome in Pediatric Patients Undergoing Correction of Ventricular Septal Defect","authors":"H. Golab, M. Wijers, M. Witsenburg, G. Bol-Raap, E. Cruz, A. Bogers","doi":"10.1051/ject/2000322089","DOIUrl":"https://doi.org/10.1051/ject/2000322089","url":null,"abstract":"Moderate hypothermia of 28°C is widely accepted in cardiac surgery with cardiopulmonary bypass (CPB). Recently, however, several studies suggested that normothermic or “tepid” bypass techniques may improve the clinical outcome for patients undergoing cardiac operations.\u0000To assess the effect of bypass temperature management strategy in pediatric patients undergoing correction of ventricular septal defect, 26 patients with body weight under 10 kg were randomly assigned to two treatment groups: Group 1, mild hypothermia, patients cooled to nasopharyngeal temperature of 32°C during the bypass; or Group 2, moderate hypothermia of 28°C. Clinical parameters were recorded, and blood samples were obtained just before, during, and 24 hours after operation.\u0000All the population characteristics and intraoperative variables were similar in the two groups. Hematologic data after CPB and protamine administration revealed a significantly (p < .05) longer activated partial thromboplastin time in the 32°C group; however, the difference in blood loss did not reach significance. Our study shows that both perfusion temperatures equally well facilitated CPB for this type of intracardiac surgery.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121669321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Life-threatening malignant hyperthermia and/or related disorders can rapidly strike the genetically susceptible individual when exposed to certain anesthetic agents, producing an acute syndrome in which death is likely unless immediate treatment is provided. This case report describes the use of cardiopulmonary bypass and ultrafiltration to resuscitate a moribund 10-year-old female who developed cardiac arrest from rhabdomyolytic hyperkalemia while receiving a general anesthetic for elective tonsillectomy. Subsequent muscle biopsy indicated the patient was susceptible to malignant hyperthermia.
{"title":"Successful Use of Cardiopulmonary Bypass and Ultrafiltration for Metabolic Resuscitation of a Moribund Child With Acute Perianesthetic Rhabdomyolysis: A Case Report of Unsuspected Malignant Hyperthermia","authors":"J. Edwards, J. K. Hamby, L. Siwek","doi":"10.1051/ject/2000322103","DOIUrl":"https://doi.org/10.1051/ject/2000322103","url":null,"abstract":"Life-threatening malignant hyperthermia and/or related disorders can rapidly strike the genetically susceptible individual when exposed to certain anesthetic agents, producing an acute syndrome in which death is likely unless immediate treatment is provided. This case report describes the use of cardiopulmonary bypass and ultrafiltration to resuscitate a moribund 10-year-old female who developed cardiac arrest from rhabdomyolytic hyperkalemia while receiving a general anesthetic for elective tonsillectomy. Subsequent muscle biopsy indicated the patient was susceptible to malignant hyperthermia.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128288559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Potential problems have occurred during cardiopulmonary bypass where the area directly above the outlet port of the soft-shell venous reservoir containing a screen has collapsed similar to when the bag is empty, although there are still several hundred milliliters in the bag. A preliminary investigation was conducted to rule out the possibility of this outflow obstruction being attributable to poor flow design through the reservoirs. The test circuit consisted of a cardiotomy reservoir, a centrifugal pump, 3/8 and 1/2 in PVC tubing, and one of the test venous reservoirs (BARD S-2116, Medtronic 1385 and MVR-1600, Sarns 4858). The circuit was primed with outdated packed red blood cells, platelets, human albumin, normal saline, and 10,000 units of sodium heparin in concentrations to simulate routine bypass. Each reservoir was tested at 6.5–7.0 L/min flows for a least 20 min each. None of the reservoirs tested demonstrated the phenomenon that had been observed clinically. This dismisses flow design flaws as a possible cause. Further clinical investigation must be performed to identify the possible cause or causes of this problem.
{"title":"Outflow Obstruction of Soft-Shell Venous Reservoir Bags: A Preliminary Investigation","authors":"D. Palanzo, R. M. Montesano, Joseph M Castagna","doi":"10.1051/ject/2000322066","DOIUrl":"https://doi.org/10.1051/ject/2000322066","url":null,"abstract":"Potential problems have occurred during cardiopulmonary bypass where the area directly above the outlet port of the soft-shell venous reservoir containing a screen has collapsed similar to when the bag is empty, although there are still several hundred milliliters in the bag. A preliminary investigation was conducted to rule out the possibility of this outflow obstruction being attributable to poor flow design through the reservoirs. The test circuit consisted of a cardiotomy reservoir, a centrifugal pump, 3/8 and 1/2 in PVC tubing, and one of the test venous reservoirs (BARD S-2116, Medtronic 1385 and MVR-1600, Sarns 4858). The circuit was primed with outdated packed red blood cells, platelets, human albumin, normal saline, and 10,000 units of sodium heparin in concentrations to simulate routine bypass. Each reservoir was tested at 6.5–7.0 L/min flows for a least 20 min each.\u0000None of the reservoirs tested demonstrated the phenomenon that had been observed clinically. This dismisses flow design flaws as a possible cause. Further clinical investigation must be performed to identify the possible cause or causes of this problem.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130760191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heparin-induced thrombocytopenia and its related complications can be life-threatening in patients undergoing cardiopulmonary bypass (CPB) with heparin exposure. While the literature illustrates many different techniques which might be employed in this situation, most are used infrequently. This case report provides an overview of the successful use of r-Hirudin, and associated monitoring techniques, in a high-risk patient undergoing cardiac surgery utilizing CPB.
{"title":"The Use of r-Hirudin During Cardiopulmonary Bypass in a Patient with Heparin Induced Thrombocytopenia","authors":"D. Webb, M. S. Viñas, D. Drinkwater, W. Merrill","doi":"10.1051/ject/2000322107","DOIUrl":"https://doi.org/10.1051/ject/2000322107","url":null,"abstract":"Heparin-induced thrombocytopenia and its related complications can be life-threatening in patients undergoing cardiopulmonary bypass (CPB) with heparin exposure. While the literature illustrates many different techniques which might be employed in this situation, most are used infrequently. This case report provides an overview of the successful use of r-Hirudin, and associated monitoring techniques, in a high-risk patient undergoing cardiac surgery utilizing CPB.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122639146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Lalone, M. Turrentine, K. Bando, Chris C. Frederick, M. Horner, L. Richmond, Alexander P. Bezruczko, S. Morris, Deborah L. Frankenberg, John W. Brown
Perfusion practice surveys on modified ultrafiltration show most clinicians reporting the use of arterial to venous cannulation. With an arterial–venous (A–V) approach, the patient’s blood is accessed in a retrograde direction from the cardiopulmonary bypass aortic cannula, and the hemoconcentrated blood is returned to a catheter placed at a systemic venous return site. To avoid possible hazards of these arterial–venous techniques, we developed a veno–venous (V–V) modified ultrafiltration circuit and method that: (1) uses an 11.5 F dual-lumen hemodialysis catheter placed at a right atrial cannulation site for concomitant pickup and return of the patient’s blood; (2) places the ultrafiltration circuit within the cardioplegia delivery system, enabling the use of the heat exchanger/bubble trap features and also allowing hemoconcentration during cardiopulmonary bypass; and (3) uses an elevated, collapsible transfusion bag within the circuit as a holding reservoir for crystalloid-chased blood from the CPB circuit. The product literature and our lab testing of the hemodialysis catheter indicates adequate hemodynamics for modified ultrafiltration in children, and our clinical experience shows routine completion of the process in about 10–15 min (12.67 ± 1.73 mins; mean ± 1 SD, N = 9). Advantages of this V–V approach compared to A–V access include: (1) no potential aortic air entrainment at the aortic cannula purse-string suture; (2) modified ultrafiltration in patients regardless of aortic size or anatomy; and (3) avoidance of significant arterial to venous shunts during the performance of modified ultrafiltration. The elevated reservoir within the modified ultrafiltration circuit allows: (1) efficient pre- and/or postultrafiltration fluid chasing of blood from the main cardiopulmonary bypass circuit, thereby keeping it safely primed and allowing for the concentration of all circuit contents before and/or following the ultrafiltration method; (2) maintenance of desired patient filling pressures, temperature, and blood oxygen saturation within the ultrafiltration circuit by intermittent addition of warmed, oxygenated blood to the V–V modified ultrafiltration circuit.
对改良超滤的灌注实践调查显示，大多数临床医生报告使用动脉到静脉插管。采用动-静脉(a - v)入路，患者的血液从体外循环主动脉导管逆行进入，血液浓缩后的血液回流到放置在全身静脉回流部位的导管中。为了避免这些动-静脉技术可能带来的危害，我们开发了一种改良的静脉-静脉(V-V)超滤回路和方法:(1)在右心房插管部位放置11.5 F双腔血液透析导管，同时取血和回血;(2)将超滤电路置于心脏骤停输送系统中，使热交换器/气泡阱功能得以使用，并允许体外循环期间的血液浓缩;(3)在回路内使用升高的可折叠输血袋作为CPB回路中追逐结晶的血液的储存库。产品文献和我们对血液透析导管的实验室测试表明，改良超滤在儿童中有足够的血流动力学，我们的临床经验表明，常规过程约在10-15分钟(12.67±1.73分钟)内完成;平均值±1 SD, N = 9)。与A-V入路相比，V-V入路的优点包括:(1)主动脉导管荷包缝合处无主动脉空气夹带的可能;(2)改良超滤，无论主动脉大小或解剖结构如何;(3)在改良超滤过程中避免明显的动脉到静脉分流。改进后的超滤回路内升高的储藏库允许:(1)高效的超滤前和/或超滤后液体追踪来自主体外循环的血液，从而保持其安全，并允许在超滤方法之前和/或之后浓缩所有回路内容物;(2)通过向V-V修饰的超滤电路中间歇添加温热、含氧的血液来维持患者所需的超滤电路内的充注压力、温度和血氧饱和度。
{"title":"Modified Ultrafiltration After Congenital Heart Surgery: A Veno–Venous Method Using a Dual-Lumen Hemodialysis Catheter","authors":"B. Lalone, M. Turrentine, K. Bando, Chris C. Frederick, M. Horner, L. Richmond, Alexander P. Bezruczko, S. Morris, Deborah L. Frankenberg, John W. Brown","doi":"10.1051/ject/2000322095","DOIUrl":"https://doi.org/10.1051/ject/2000322095","url":null,"abstract":"Perfusion practice surveys on modified ultrafiltration show most clinicians reporting the use of arterial to venous cannulation. With an arterial–venous (A–V) approach, the patient’s blood is accessed in a retrograde direction from the cardiopulmonary bypass aortic cannula, and the hemoconcentrated blood is returned to a catheter placed at a systemic venous return site. To avoid possible hazards of these arterial–venous techniques, we developed a veno–venous (V–V) modified ultrafiltration circuit and method that: (1) uses an 11.5 F dual-lumen hemodialysis catheter placed at a right atrial cannulation site for concomitant pickup and return of the patient’s blood; (2) places the ultrafiltration circuit within the cardioplegia delivery system, enabling the use of the heat exchanger/bubble trap features and also allowing hemoconcentration during cardiopulmonary bypass; and (3) uses an elevated, collapsible transfusion bag within the circuit as a holding reservoir for crystalloid-chased blood from the CPB circuit.\u0000The product literature and our lab testing of the hemodialysis catheter indicates adequate hemodynamics for modified ultrafiltration in children, and our clinical experience shows routine completion of the process in about 10–15 min (12.67 ± 1.73 mins; mean ± 1 SD, N = 9). Advantages of this V–V approach compared to A–V access include: (1) no potential aortic air entrainment at the aortic cannula purse-string suture; (2) modified ultrafiltration in patients regardless of aortic size or anatomy; and (3) avoidance of significant arterial to venous shunts during the performance of modified ultrafiltration. The elevated reservoir within the modified ultrafiltration circuit allows: (1) efficient pre- and/or postultrafiltration fluid chasing of blood from the main cardiopulmonary bypass circuit, thereby keeping it safely primed and allowing for the concentration of all circuit contents before and/or following the ultrafiltration method; (2) maintenance of desired patient filling pressures, temperature, and blood oxygen saturation within the ultrafiltration circuit by intermittent addition of warmed, oxygenated blood to the V–V modified ultrafiltration circuit.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116970728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Trowbridge, K. R. Woods, M. Muhle, K. Niimi, K. Tremain, Jun Jiang, A. Stammers
Myocardial preservation demands the precise and accurate delivery of cardioplegic solutions to provide nutritive delivery and metabolic waste removal. The purpose of this study was to evaluate the performance characteristics of the Medtronic® CSS™ Cardioplegia Safety System in an in vitro setting. The CSS™ was evaluated under the following conditions: blood to crystalloid ratios of 1:0, 1:1, 4:1, 8:1, 0:1; potassium concentrations of 10, 20, and 40 mEq L−1; volumetric delivery collection at 100, 250, 500, 750, and 990 mL/min; pressure accuracy at 100 and 300 mmHg; and system safety mechanisms. Measured and predicted values from the CSS were compared using one way ANOVA, with statistical significance accepted at p ≤ 0.05. The measured values for the tested ratios and volume collections were all within the manufacturer’s technical parameters. Potassium concentration results were all within expected values except at 100 mL/min, where the measured value of 17.1 ± 2.1 mmol was lower than the expected 20.0 ± 0.2 mmol (p < .034). As flow rates changed, the CSS line pressure error was constant (0.5 to 3.7%), and the only significant difference was observed at 100 mmHg, 500 mL/min (102.3 ± 1.7 vs. 100.0 ± 0.0 mmHg, P < .003). The device performed accurately and reliably under all simulated safety conditions, including bubble detection, over pressurization and battery backup. In conclusion, the performance of the CSS was within the manufacturer’s specifications for the majority of the tested conditions and operated safely when challenged under varying conditions.
心肌保存需要精确和准确地提供心脏麻痹解决方案，以提供营养输送和代谢废物清除。本研究的目的是在体外环境中评估美敦力®CSS™心脏骤停安全系统的性能特征。CSS™在以下条件下进行评价:血晶比为1:0、1:1、4:1、8:1、0:1;钾浓度分别为10、20和40 mEq L−1;在100、250、500、750和990 mL/min下进行体积递送收集;压力精度在100和300 mmHg;以及系统安全机制。CSS的实测值和预测值采用单因素方差分析(one - way ANOVA)进行比较，p≤0.05接受统计学显著性。测试比例和体积集合的测量值都在制造商的技术参数范围内。除100 mL/min时(17.1±2.1 mmol)低于20.0±0.2 mmol (p < 0.034)外，钾浓度结果均在预期范围内。随着流量的变化，CSS管路压力误差恒定(0.5 ~ 3.7%)，仅在100 mmHg和500 mL/min时存在显著差异(102.3±1.7 vs. 100.0±0.0 mmHg, P < 0.003)。该设备在所有模拟安全条件下都能准确可靠地运行，包括气泡检测、过压和电池备用。总之，在大多数测试条件下，CSS的性能在制造商的规格范围内，并且在不同条件下受到挑战时安全运行。
{"title":"In Vitro Evaluation of the Medtronic™ Cardioplegia Safety System®","authors":"C. Trowbridge, K. R. Woods, M. Muhle, K. Niimi, K. Tremain, Jun Jiang, A. Stammers","doi":"10.1051/ject/2000322031","DOIUrl":"https://doi.org/10.1051/ject/2000322031","url":null,"abstract":"Myocardial preservation demands the precise and accurate delivery of cardioplegic solutions to provide nutritive delivery and metabolic waste removal. The purpose of this study was to evaluate the performance characteristics of the Medtronic® CSS™ Cardioplegia Safety System in an in vitro setting.\u0000The CSS™ was evaluated under the following conditions: blood to crystalloid ratios of 1:0, 1:1, 4:1, 8:1, 0:1; potassium concentrations of 10, 20, and 40 mEq L−1; volumetric delivery collection at 100, 250, 500, 750, and 990 mL/min; pressure accuracy at 100 and 300 mmHg; and system safety mechanisms. Measured and predicted values from the CSS were compared using one way ANOVA, with statistical significance accepted at p ≤ 0.05.\u0000The measured values for the tested ratios and volume collections were all within the manufacturer’s technical parameters. Potassium concentration results were all within expected values except at 100 mL/min, where the measured value of 17.1 ± 2.1 mmol was lower than the expected 20.0 ± 0.2 mmol (p < .034). As flow rates changed, the CSS line pressure error was constant (0.5 to 3.7%), and the only significant difference was observed at 100 mmHg, 500 mL/min (102.3 ± 1.7 vs. 100.0 ± 0.0 mmHg, P < .003). The device performed accurately and reliably under all simulated safety conditions, including bubble detection, over pressurization and battery backup. In conclusion, the performance of the CSS was within the manufacturer’s specifications for the majority of the tested conditions and operated safely when challenged under varying conditions.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114275518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Tassani, Martin Pfauder, J. Richter, H. Meisner
The aim of this study was to determine: 1) whether a bilateral perfusion circuit (Drew technique) using the patient's own lung as the oxygenator is feasible for multi-vessel coronary artery bypass grafting; and 2) if the systemic inflammatory response to extracorporeal circulation differs compared to conventional cardiopulmonary bypass procedures. Twenty patients were enrolled in a randomized, controlled study. In the Drew group (n=10) bilateral perfusion was used. The other patients (n= 1 0) were operated on with conventional perfusion techniques and served as the control group. Pro- (interleukin-6) and anti-inflammatory (interleukin-10) mediators were measured before operation, during rewarming, 30 min, 2, 4, and 24 hours after extracorporeal circulation. The results show that: 1) multi-vessel coronary artery bypass grafting could be performed during 90 ± 8 min of bilateral cardiopulmonary bypass; 2) the concentration of the interleukin-6 was significantly lower in the Drew group at 2 hours (449 ± 82 versus 914 ± 152 pg/ml, p = 0.02), and 24 hours (146 ± 38 versus 424 ± 98 pg/ml, p = 0.02), after cardiopulmonary bypass. The Drew technique seems to be a promising method of extracorporeal circulation which: 1) can safely be used during routine coronary bypass grafting procedures; and 2) significantly reduces the systemic inflammatory response as compared to conventional extracorporeal circulation.
本研究的目的是确定:1)双侧灌注回路(Drew技术)使用患者自己的肺作为氧合器是否适用于多支冠状动脉旁路移植术;2)与常规体外循环手术相比，体外循环的全身炎症反应是否不同。20名患者参加了一项随机对照研究。Drew组(n=10)采用双侧灌注。其余10例患者行常规灌注手术，作为对照组。分别于手术前、复温时、体外循环后30 min、2、4和24 h测定促白细胞介素-6和抗炎介质。结果表明:1)双侧体外循环90±8 min可完成多支冠状动脉旁路移植术;2)德鲁组体外循环后2小时(449±82比914±152 pg/ml, p = 0.02)和24小时(146±38比424±98 pg/ml, p = 0.02)白细胞介素-6浓度明显降低。德鲁技术似乎是一种很有前途的体外循环方法:1)可以安全地用于常规冠状动脉旁路移植术;2)与常规体外循环相比，显著降低全身炎症反应。
{"title":"Bilateral Extracorporeal Circulation (“Drew Technique”) for Coronary Artery Bypass Surgery using Patient’s Lung as Oxygenator","authors":"P. Tassani, Martin Pfauder, J. Richter, H. Meisner","doi":"10.1051/ject/1999311006","DOIUrl":"https://doi.org/10.1051/ject/1999311006","url":null,"abstract":"The aim of this study was to determine: 1) whether a bilateral perfusion circuit (Drew technique) using the patient's own lung as the oxygenator is feasible for multi-vessel coronary artery bypass grafting; and 2) if the systemic inflammatory response to extracorporeal circulation differs compared to conventional cardiopulmonary bypass procedures.\u0000Twenty patients were enrolled in a randomized, controlled study. In the Drew group (n=10) bilateral perfusion was used. The other patients (n= 1 0) were operated on with conventional perfusion techniques and served as the control group. Pro- (interleukin-6) and anti-inflammatory (interleukin-10) mediators were measured before operation, during rewarming, 30 min, 2, 4, and 24 hours after extracorporeal circulation.\u0000The results show that: 1) multi-vessel coronary artery bypass grafting could be performed during 90 ± 8 min of bilateral cardiopulmonary bypass; 2) the concentration of the interleukin-6 was significantly lower in the Drew group at 2 hours (449 ± 82 versus 914 ± 152 pg/ml, p = 0.02), and 24 hours (146 ± 38 versus 424 ± 98 pg/ml, p = 0.02), after cardiopulmonary bypass.\u0000The Drew technique seems to be a promising method of extracorporeal circulation which: 1) can safely be used during routine coronary bypass grafting procedures; and 2) significantly reduces the systemic inflammatory response as compared to conventional extracorporeal circulation.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132731815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study was designed to evaluate the myocardial protective effect of exogenous creatine phosphate (CP) added to cardioplegic solution for use in open heart surgery. Ninety-eight patients were divided into a control group (n = 44) and a CP group (n =54). The spontaneous recovery rate of heart beat after aortic declamping was recorded and changes of serum enzymes including CPK, LDH, CPK-MB, HBDH, and AST were evaluated. The ultrastructural alterations of the myocardial tissue were observed in 4 patients (2 cases from each group) who had cardiac valve replacement. The spontaneous recovery rate of heart beat in the CP group was significantly higher than the control group (39/54 versus 22/44 ), and the peak values of leakage of serum enzymes of the control group appeared earlier and receded later than those of the CP group. Electron microscope examination revealed better preservation of the ultrastructures of the myocardial tissue in the CP group than that of the control group. This data indicates that exogenous creatine phosphate added to the cardioplegic solution offers a better protective effect on the ischemic myocardium during open heart surgery.
{"title":"Clinical Study of the Protective Effect of Exogenous Creatine Phosphate on Ischemic Myocardium during Open Heart Surgery","authors":"P. Dong, Jing Yang, Yu-ying Pan, Y. Guan, M. He","doi":"10.1051/ject/1999311012","DOIUrl":"https://doi.org/10.1051/ject/1999311012","url":null,"abstract":"This study was designed to evaluate the myocardial protective effect of exogenous creatine phosphate (CP) added to cardioplegic solution for use in open heart surgery.\u0000Ninety-eight patients were divided into a control group (n = 44) and a CP group (n =54). The spontaneous recovery rate of heart beat after aortic declamping was recorded and changes of serum enzymes including CPK, LDH, CPK-MB, HBDH, and AST were evaluated. The ultrastructural alterations of the myocardial tissue were observed in 4 patients (2 cases from each group) who had cardiac valve replacement.\u0000The spontaneous recovery rate of heart beat in the CP group was significantly higher than the control group (39/54 versus 22/44 ), and the peak values of leakage of serum enzymes of the control group appeared earlier and receded later than those of the CP group. Electron microscope examination revealed better preservation of the ultrastructures of the myocardial tissue in the CP group than that of the control group. This data indicates that exogenous creatine phosphate added to the cardioplegic solution offers a better protective effect on the ischemic myocardium during open heart surgery.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133457765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Beck, M. S. Dickes, C. C. Jones, M. L. Pierce, Zuorui Song, Kimberly J Taft, A. Stammers
The optimum model for hemostasis monitoring during cardiopulmonary bypass (CPB) is the evaluation of physiologic changes in the intact organism. This is often logistically difficult and expensive. The purpose of this study was to design an in vitro model of blood coagulation for use in simulated CPB. Human expired blood components within 4 days of outdating were reconstitituted as follows: 4 units of packed red blood cells, 4 units of platelets, and 3 units of fresh frozen plasma. The mixture was circulated in a simulated extracorporeal circuit. Blood samples were drawn every 30 minutes over a 2 hour period, recalcified, and analyzed for platelet count (PL T), fibrinogen concentration (FIB), prothrombin time (PT), activated partial thromboplastin time (aPTT), celite and kaolin activated clotting times (ACT), and thrombelastography (TEG). In the four different coagulation monitors utilized, there were no significant changes in celite or kaolin ACTs. PT increased from 15.8 ± 1.1 sec to 25.2 ± 7.8 sec and aPTT from 62.1 ± 15.9 sec to 78.9 ± 36.5 sec (p = NS). There were no changes in either PL T count or FIB concentration. Both celite and tissue factor activated TEG values trended towards hypocoagulability. In conclusion, the results show that the in vitro model is stable over 120 min of recirculation time within a simulated cardiopulmonary bypass circuit in regards to platelet count, hematocrit, total protein, PT, aPTT, and ACT. Further examination will be necessary to establish the effects of the model in regard to platelet function.
{"title":"An In Vitro Model for Hemostasis Monitoring During Simulated Cardiopulmonary Bypass","authors":"D. Beck, M. S. Dickes, C. C. Jones, M. L. Pierce, Zuorui Song, Kimberly J Taft, A. Stammers","doi":"10.1051/ject/1998303127","DOIUrl":"https://doi.org/10.1051/ject/1998303127","url":null,"abstract":"The optimum model for hemostasis monitoring during cardiopulmonary bypass (CPB) is the evaluation of physiologic changes in the intact organism. This is often logistically difficult and expensive. The purpose of this study was to design an in vitro model of blood coagulation for use in simulated CPB.\u0000Human expired blood components within 4 days of outdating were reconstitituted as follows: 4 units of packed red blood cells, 4 units of platelets, and 3 units of fresh frozen plasma. The mixture was circulated in a simulated extracorporeal circuit. Blood samples were drawn every 30 minutes over a 2 hour period, recalcified, and analyzed for platelet count (PL T), fibrinogen concentration (FIB), prothrombin time (PT), activated partial thromboplastin time (aPTT), celite and kaolin activated clotting times (ACT), and thrombelastography (TEG).\u0000In the four different coagulation monitors utilized, there were no significant changes in celite or kaolin ACTs. PT increased from 15.8 ± 1.1 sec to 25.2 ± 7.8 sec and aPTT from 62.1 ± 15.9 sec to 78.9 ± 36.5 sec (p = NS). There were no changes in either PL T count or FIB concentration. Both celite and tissue factor activated TEG values trended towards hypocoagulability.\u0000In conclusion, the results show that the in vitro model is stable over 120 min of recirculation time within a simulated cardiopulmonary bypass circuit in regards to platelet count, hematocrit, total protein, PT, aPTT, and ACT. Further examination will be necessary to establish the effects of the model in regard to platelet function.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121838357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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